Book Review

Charcot: Constructing neurology

N Engl J Med 1996; 335:1076-1077October 3, 1996

Article

Charcot: Constructing neurology
By Christopher G. Goetz, Michel Bonduelle, and Toby Gelfand. 392 pp., illustrated. New York, Oxford University Press, 1995. $39.95. ISBN: 0-19-507643-5

Jean-martin Charcot (1825–1893) made extraordinary contributions to the nosology of neurologic diseases and played a pivotal part in establishing neurology as a clinical specialty. Despite Charcot's accomplishments, the only comprehensive biography of him was published by Georges Guillain ( J.-M. Charcot, 1825–1893, Sa Vie — Son Oeuvre. Paris: Masson, 1955). Written for a broad reading public, this excellent work discusses the man, his personality, and his private and professional life and describes his contributions in a manner accessible to the non-neurologist. However, it does not thoroughly analyze his research or the substantial effect of Charcot's contributions to the birth of neurology as an independent specialty. More than 40 years after Guillain's book, Goetz, Bonduelle, and Gelfand have written an outstanding, in-depth account of the scientific accomplishments and life of Charcot, based on an exhaustive examination of primary sources, some of them unpublished and reviewed here for the first time.

The book examines Charcot's education and medical career, which spanned 50 years, from the time he entered medical school in Paris in 1843 until his death at the age of 67. After several setbacks in his academic advancement, Charcot reached the rank of professor at the Paris Medical School in 1872 and occupied the chair of pathologic anatomy. His early works concerned a wide range of subjects in pathology and medicine, but after he became chief of service at the Salpêtrière hospital in 1862, his interests shifted toward neurology. His remarkable contributions led to the establishment of the first chair of diseases of the nervous system, which was bestowed on him in 1882. The authors analyze his research and teachings, encompassing a large spectrum of neurologic disorders that include progressive muscular atrophy (Charcot–Marie–Tooth disease), amyotrophic lateral sclerosis (Charcot's disease), tabes dorsalis (Charcot's joints), multiple sclerosis, Parkinson's disease, aphasia, hysteria, and neurologic localization. Charcot's contributions are presented in the context of the medical knowledge of the time; their importance to the birth of neurology as a specialty is critically assessed. He built the field of neurology by combining clinical observation and laboratory research, relying on strict observation in his neuropathological studies.

The authors assess Charcot's scientific legacy and the fate of his students after his death. Without his support, his students lost favor to candidates from competing schools. His rising star, Pierre Marie, 39 years old at Charcot's death, had to wait 24 years to occupy his mentor's chair. Others, such as Babinski and Gilles de la Tourette, were relegated to lesser positions, never achieving the rank of professor.

The book also examines Charcot's social and family life and provides a glimpse into his personality. He comes across as an aloof, despotic, and self-aggrandizing man, hungry for recognition and glory, who was also shy, sensitive to criticism, and firm in support of his pupils. His innermost personality will remain unknown, however, since he never kept a diary or wrote intimate, personal letters.

The authors — an American neurologist, a French neurologist, and a Canadian historian of medicine — are recognized experts in the history of French neurology and have all written studies of Charcot's work independently. Their collaboration has produced a superb book, the most comprehensive and authoritative work to date on Charcot and his time. However, it does not include a list of his publications. The style is clear, typographic errors are few, and minor inconsistencies and repetitions do not detract from the generally outstanding quality of the work. Those with an interest in neuroscience or medical history who venture into its pages will not be able to put it down.

Vicente J. Iragui, M.D., Ph.D.
University of California, San Diego, La Jolla, CA 92093

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